Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Clinic Coordinator Interview New 4 2 0 Form 0920-24CB Clinic Coordinator Interviews_Interview Guide
Patient Eligibility Screener New 900 120 0 Form 0920-24CB Patient Eligibility Screener_English
Form 0920-24CB Patient Eligibility Screener_Spanish
Post-clinic Survey New 900 300 0 Form 0920-24CB Post-Clinic Visit Survey_Online_English
Form 0920-24CB Post-Clinic Visit Survey_Online_Spanish
Post-exposure survey New 900 300 0 Form 0920-24CB Post Exposure Survey _English
Form 0920-24CB Post Exposure Survey _Spanish
Pre-exposure Survey New 900 300 0 Form 0920-24CB Pre-Exposure Survey_Online_English
Form 0920-24CB Pre-Exposure Survey_Online_Spanish
Provider Survey New 40 7 0 Form 0920-24CB Provider Survey
Usability Survey New 300 90 0 Form 0920-24CB Usability Survey_Online_English
Form 0920-24CB Usability Survey_Online_Spanish
User Experience Interview New 30 10 0 Form 0920-24CB User Experience Interviews_Interview Guide_English
Form 0920-24CB User Experience Interviews_Interview Guide_Spanish
Total burden requested under this ICR: 3974 1129 0  
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